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CORE: Thoracic > Diffuse lung disease > Flashcards

Diffuse lung disease Flashcards

1
Q

IPF: mean survival, prognosis, symptoms, patient population

A

most common idiopathic interstitial pneumonia; second worse prognosis (2-4 yrs survival)

dry cough, >50 yo

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2
Q

pathological diagnosis of IPF

A

usual interstitial pneumonia

interstitial fibroblastic foci and chronic alveolar inflammation

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3
Q

usual interstitial pneumonia causes

A

IPF, collagen vascular disease, drug injury, asbestosis

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4
Q

UIP imaging

A

early: irregular reticulation in posterior subpleural lung bases
late: fibrosis, traction bronchiectasis, posterior subpleural honeycombing

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5
Q

nonspecific interstitial pneumonitis: patient population, prognosis, forms

A

younger patients 40-50yo

responds to steroids

fibroitic and cellular NSIP forms

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6
Q

causes of NSIP

A

idiopathic, most common manifestation of collagen vascular disease, drug reaction, occupational exposure, dermatomyositis

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7
Q

fibroitic NSIP

A

GCO with fine reticulation and traction bronchiectasis

lacks honeycombing (honeycombing with UIP)

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8
Q

cellular NSIP

A

GCO without significant fibroitic changes; worse prognosis than fibrotic NSIP

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9
Q

NSIP imaging

A

sparing of immediate subpleural lung (unlike UIP)

posterior peripheral lower lobes

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10
Q

cryptogenic organizing pneumonia, previously bonchiolitis obliterans organizing pneumonia (BOOP): prognosis, treatment

A

good prognosis, may resolve completely with steroids

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11
Q

pathology of COP

A

granulation tissue polyps that fill airways in response to infection, drug inhalation, inhalation

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12
Q

COP imaging

A

mixed consolidation and ground glass opacities in peripheral and peribronchovasculat distribution

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13
Q

reverse halo/atoll sign

A

specific for OP

central lucency surounded by ground glass halo

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14
Q

halo sign

A

invasive aspergilus

central opacity with ground glass opacity

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15
Q

respiratory bronchiolitis-interstitial lung disease (RB–ILD)

A

common in smokers; pigmented macrophages present in respiratory bronchioles

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16
Q

histology respiratory bronchiolitis- ILD

A

sheets of macrophages filling terminal airways; sparing of alveoli

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17
Q

RB ILD imaging features

A

centrilobular nodules, patchy ground glass opacities

random distribution

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18
Q

desquamative interstitial pneumonia imaging

A

diffuse basal predominant patchy/subpleural ground glass opacification; few csts

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19
Q

DIP histology

A

brown pigmented macrophages; sheets of macrophages extend into alveoli

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20
Q

lymphoid interstitial pneumonia

A

rare; associated with Sjogren syndrome or HIV

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21
Q

histology lymphoid interstitial pneumonia

A

diffuse infiltration of interstitium by lymphocytes; distortion of alveoli

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22
Q

imaging lymphoid interstitial pneumonia

A

diffuse/lower lobe predominant ground glass; thin walled perivascular cysts present

may cause pneumothorax in advanced cases

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23
Q

acute interstitial pneumonia aka diffuse alveolar damage

A

seen with ARDS; acute onset and worst prognosis

caused by surfactant destruction

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24
Q

phases of acute interstitial pneumonia

A

early: exudative; hyaline membranes, diffuse alveolar infiltration by immune cells; noncardiogenic pulmonary edema
chronic: organizazing: alveolar wall thickkening due to granulation tissue; >1 w after injury

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25
Q

AIP imaging

A

extensive geographic GGO

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26
Q

inhalation lung disease localization

A

upper lobes

lower lobes have better blood flow/lymphatic drainage

27
Q

hypersensitivity pneumonitis (HSP)

A

hypersensitivity reaction

causes: bird proteins, thermophilic actinomycetes; organic dust

28
Q

phases of HSP

A

acute: inflammatory exudate fill alveoli; GGO/consolidations; small centrilobular nodules
subacute: centrilobular GG nodules; mosaic attenuation; “head cheese sign”
chronic: upper lobe predominant pulmonary fibrosis

29
Q

pneumoconioses

A

inorganic dust inhalation (silicosis, coal workers pneumoconiosis, asbestosis)

30
Q

most common types of pneumoconioses

A

silicosis/CWP

31
Q

imagine findings of silicosis/coal workers lung

A

uncomplicated: multiple upper lobe predminant centrilobular/subpleural nodules
complicated: large conglomerate masses/massive fibrosis

32
Q

eggshell lymph node calcifications

A

silicosis, less common CWP

33
Q

increased risk of ? with pneumoconiosis

A

TB

34
Q

Caplan syndrome

A

rheumatoid arthritis + CWP or silicosis

necrobiotic rheumatoid nodules superimposed on centrilobular/subpleural nodules of pneumoconiosis

35
Q

asbestosis, distribution

A

inhalation of asbestosis fibers > pulmonary fibrosis > UIP pathology

primarily affects lower lobes since they are too large to be removed by alveolar macrophages/lymphatics

36
Q

imaging findings of asbestosis

A

similar to IPF but have pleural thickening and plaques

37
Q

eosinophilic lung disease

A

simple pulmonary eosinophilia/Loffler syndrome; chronic eosinophilic pneumonia

38
Q

simple pulmonary eosinophilia/Loffler syndrome

A

transient, migratory areas of focal consolidation; elevated eosinophil count in peripheral smear

similar appearance with parasitic disease and drug reactions

39
Q

chronic eosinophilic pneumonia

A

extensive alveolar filling/interstitial infiltration with inflammatory eosinophils

patchy, peripheral, upper lobe predominance

responds to steroids

40
Q

pulmonary vasculitis

A

churg straus/allergic angiitis and granulomatosis, microscopic polyangitis, Wegner granulomatosis

41
Q

Churg Strauss/Allergic Angiitis and Granulomatosis

A

small vessel vasculitis + asthma + peripheral eosinophilia

P-ANCA+

peripheral consolidation/ground glass

42
Q

Microscopic polyangitis

A

common cause of pulmonary hemorrhage with renal failure

P-ANCA +

diffuse central-predominant ground glass representing hemorrhage

43
Q

Wegener granulomatosis

A

systemic small vessel vasculitis with sinusitis + lungs + renal

C-ANCA+

can cause airway stenosis (nasopharyngeal/eustachian tube obstruction)

multiple cavitary lung nodules that don’t respond to antibiotics

44
Q

pulmonary manifestations of drug toxicity

A

pulmonary edema, ARDS, organizing pneumonia, eosinophilic pneumonia, bronchiolitis obliterans, pulmonary hemorrhage, NSIP, UIP

45
Q

radiation lung injury

A

confined to radiation port; crosses anatomic margins

radiation pneumonitis: 1-4 months

radiation fibrosis: 6-12 mo

46
Q

sarcoidosis

A

noncaseating granulomas that form nodules/masses throughout body

pulmonary sarcoid > fibrosis mid/upper lung predominance

47
Q

CXR staging of sarcoidosis

A

Stage 0: Normal radiograph.
Stage 1: Hilar or mediastinal adenopathy only, without lung changes. Stage 2: Adenopathy with lung changes.
Stage 3: Diffuse lung disease without adenopathy.
Stage 4: End-stage fibrosis.

48
Q

lateral radiograph “donut sign”

A

adenopathy circumferentially encircling trachea

49
Q

CT findings of sarcoid

A

adenopathy, upper lobe predominant perilymphatic nodules of varying sizes/granulomas

bronchial involvement > air trapping

galaxy sign with coalescing nodules into mass

50
Q

pulmonary langerhans cell histiocytosis

A

smoking related lung disease

nodules associated with airways that form irregular cysts; upper lobe predominant, peribronchovascular nodules

spare costophrenic sulci

51
Q

smoking related lung disease

can cause spontaneous pneumothorax

may also affect bones, DI from hypophysitis, skin involvement

A

pulmonary langerhans cell histiocytosis, RB-ILD, DIP

52
Q

DDX for pulmonary and bone involvement

A

pulmonary langerhans cell histiocytosis, malignancy, TB, fungal disease, sarcoid, Gaucher

53
Q

PLCH progression

A

nodules > cavitary nodules > IRREGULAR cysts

54
Q

treatment for PLCH

A

steroids

smoking cessation

55
Q

pulmonary alveolar proteinosis (PAP)

A

alveoli filled with proteinaceous lipid-rich material

56
Q

imaging of PAP

A

XR: pulmonary edema, perihilar opacification

CT: cazy paving in areas of geometric ground glass

57
Q

ddx for crazy paving

A

pulmonary alveolar proteinosis, pneumocystis pneumonia, COP, bronchoalveolar carcinoma, lipoid pneumonia

58
Q

PAP can have superimposed infection with what organism?

A

Nocardia

59
Q

treatment for PAP

A

bronchoalveolar lavage

60
Q

lymphangioleiomyomatosis

A

diffuse cystic lung disease cauesed by bronchiolar obstruction and lung destruction

women of child bearing age

can have pneumothorax and chylous leural effusion

61
Q

tuberous sclerosis triad

A

seizure, mental retardation, adenoma sebaceum

62
Q

LAM and TS

A

both can have identical appearing lung disease

63
Q

imaging apperance of LAM

A

numerous thin walled lung cysts; round and regular cysts (unlike LCH)

can affect all lobes (LCH is upper lobe predominant)

CORE: Thoracic (11 decks)

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